Treatment of hypertension in the hemodialysis patient: beneficial or not?

Hypertension is common in the hemodialysis population. Although hypertension in the general population has been shown to reduce survival and to accelerate atherosclerosis, leading to serious cardiac and cerebrovascular morbidity, its effects are less clear in those undergoing dialysis. This review focuses on recent studies showing a favorable outcome in hypertensive hemodialysis patients when compared with those with lower blood pressure. The possible explanations for this paradoxic relationship are examined, and practical suggestions are given for the management of hypertension in the patient undergoing hemodialysis. We also present information on the morbiditiy associated with hypertension in the hemodialysis population.